The Physician Leverage Flywheel

The most interesting and fulfilling physician careers rarely open up at once. They compound over time.

There are a few physicians I know personally whose careers are absolutely fascinating to me. What makes them so interesting is that they are multidimensional and rich in variety, and yet, taken as a whole, their careers are far more powerful than the sum of their parts.

The first is a physician I met when I first became involved with the Massachusetts Radiological Society about a decade ago. She started out with relatively humble beginnings as a young attending with some leadership roles in her radiology department. Over time, she gradually added additional leadership roles within her institution and with the American College of Radiology, and then began layering on experiences with different startups in consulting and advisory roles. Ultimately, she shifted away from academic medicine and now serves as the Chief Medical Officer of the Enterprise Imaging Division of a large healthcare company.

Another physician has built a distinctive career spanning clinical practice, healthcare AI, entrepreneurship, and investing. After leading major AI strategy and implementation efforts within a large health system, she founded a healthcare technology company focused on improving care coordination in underserved communities. She also invests in and advises healthcare AI companies, using her clinical and operational experience to influence care at scale.

It’s tempting to look at these individuals and assume there must have been a lucky break or some magic formula that enabled them to achieve such rare success and become the people who are always offered opportunities. While acknowledging the effort, intelligence, and small amount of luck required to achieve these outcomes, we also have to realize that these fascinating careers are not the result of one moment in time.

Rather, they represent what happens when the Physician Leverage Flywheel has years to compound.

None of this happened purely by luck or at one moment in time.

The flywheel represents the system through which physician knowledge and expertise, visibility, relationships and network, opportunities, and capital all reinforce one another. This is how a physician career moves from linear effort to compounding leverage.

What is a Flywheel, exactly?

From a physics perspective, a flywheel is a heavy rotating mechanical device that stores excess kinetic energy. Because a flywheel resists changes to its current state of motion, it absorbs excess energy during power surges and releases it during power drops. This is why the flywheel is difficult to move at first, but with each subsequent turn, the next turn becomes easier. Each turn stores momentum.

This has parallels with a physician career: the early turns feel very difficult, almost as if they are not amounting to anything, while the later turns become far easier once the benefits of the prior turns have accumulated.

Keep in mind, though, that the flywheel isn’t a linear ladder where you leave each rung behind as you climb. The flywheel is circular, with each component feeding back into the others. It’s also not a hustle asking for more hours. It asks for the same effort to be sequenced so that each turn builds upon the next, rather than starting over from the beginning. And it’s not a list of unrelated and uncorrelated activities.

The Physician Leverage Flywheel is a loop of activities that compounds: knowledge becomes credibility, credibility becomes relationships, relationships become opportunity and platform visibility, and opportunity becomes the capital and learning that fund the next turn.

The difference between this dynamic model and a static model, in which you simply accumulate each of those assets independently, is that the dynamic model shows what happens when the assets begin interacting. The Five Forms of Physician Leverage are the parts. The Portfolio Physician Model showed what a good collection of those parts looks like. The flywheel is the motion underneath both - it is what actually connects the parts to each other instead of letting them sit side by side.

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The Four Turns of The Flywheel

Here is how that motion actually works. The Physician Leverage Flywheel turns through four moves, and each one should be thought of by name: creation, attraction, compounding, and reinvesting.

Creation is the central thesis come to life, starting with the clinical anchor: the accumulated knowledge, trust, and judgment that grounds everything else, plus a small, bounded experiment built on top of it. The experiment produces knowledge - data and feedback that create insight and judgment - and that insight becomes an output: an article, a presentation, a project, a conference talk, a conversation. It’s essentially something visible that didn’t exist before.

Attraction is what happens once that visible object exists. Once people are able to see what you are thinking about and working on, some of them respond: they connect with you, make an introduction, or bring you an opportunity you did not go looking for.

Compounding is the result of what an engaged network does with that attention. The opportunities start to enhance each other - whether an invitation to speak, an advisory role, a consulting arrangement, a chance to invest, or a new professional path altogether. Each one deepens into credibility and capital: new relationships, access to capital, social proof, authority, income, or equity.

Reinvesting closes the loop. The feedback you get back, what people say, who they introduce you to, and what they ask for next, all tell you whether what you built is working and how to adjust the next turn. The next experiment starts from a stronger, more informed, better-positioned baseline than the last one did.

One full turn from my own life relates to the evolution of my involvement in AI projects and AI initiatives.

The creation turn began with reading radiology journals to learn which AI algorithms were already available in the market and which were in development, then formal coursework followed - the Radiological Society of North America Imaging AI Fundamentals course - so I would have a working baseline for evaluating, implementing, and monitoring AI software in clinical practice.

The attraction turn arrived from two directions at once: joining an angel investing group that invested in healthcare startups, and having them look to me for advice on healthcare companies building with AI. Additionally, I was asked by my department leadership, who knew of my interest in AI, to serve as clinical champion for our department’s initial AI software search and deployment. Both were people noticing a visible interest and pulling me toward them.

The compounding turn is where those two threads turned into real roles. The angel investing group led to advisory invitations from AI and healthcare companies and a few opportunities to invest. The clinical champion role led to a seat on our Institutional AI Advisory Board, where we evaluate AI solutions for the organization.

The reinvesting turn is still running. The Advisory Board seat has led to other downstream introductions and opportunities, including a recent invitation to be interviewed for perspectives on the challenges leaders are facing in the age of AI implementation, which is intended to ultimately be published into a book. All of this credibility and authority now feeds the next round of projects and opportunities, including this one.

Why is it so hard for physicians to start turning this flywheel?

One reason is intimidation or overwhelm about where to begin: it’s easy to look at examples like these and think, how would I ever do enough to get there? Adding to this, many physicians wait for a sense of permission before taking action, assuming someone else must give them a signal that they are allowed to begin.

Another reason is that many physicians keep their knowledge and achievements private. They have a reflexive reservation about exposing their ideas, and as a result, those thoughts never become visible outputs that the creation turn depends on.

Another reason is that physicians over-index on credentials and under-index on signal. Your CV is a living record of what you’ve already done. If you don’t talk about it, or about what you want to do next, you send no signal into the world about what you’re becoming. This is also where isolated opportunities get lost: a committee role, a side job, or a speaking invitation can each look like progress without tying into a larger thesis, which is another way busyness gets mistaken for leverage.

One of the biggest risks is quitting before the signs of success appear. This is especially challenging because there may not be a true blueprint to know how long you should work before getting those early successes. The first few turns of the flywheel will be hard, and it might feel like you’re doing it alone and with no reward. Stopping before the compounding has had a chance to prove itself and store momentum is one of the main failure modes.

Lastly, letting the clinical foundation slip away is another way that the flywheel can fall apart. All of the initial momentum and progress is put in motion from the basis of the clinical work, and letting that central anchor slip away can undermine the credibility that began those initial turns of the flywheel.

How to Begin Turning the Flywheel

Start with something that has a low activation energy, something accessible from where you are today. For example, writing, building, or creating something visible that doesn’t require anyone else’s approval are good starting points. Something where you don’t need to see signal back immediately is also a strong choice. These examples might be better than an advisory role or something requiring a substantial amount of capital, both of which depend on someone else’s approval.

Make sure you focus on turning one flywheel and not several simultaneously. Pick a single starting point, aligned with your central thesis, and let it run its full course before starting a second flywheel. This allows you to focus your energy and give the first flywheel time to store its energy, compound, and run its course.

Manage your expectations. Little to no signal in the early stages is expected. Keep track of the process and the loop itself, while keeping tabs on the outcome as well, so that the underlying mechanism stays visible even if the return signal isn’t there yet.

Once you start to look for the return signal, here are a few things to pay attention to:

Are people repeating your terms, language, and concepts unprompted? Are colleagues or readers making introductions to others, and are they thinking about you when opportunities come across their radar? Are you beginning to receive inbound requests for collaborations, partnerships, writing, or speaking, all without you asking? Do you notice that you’re having an easier time filtering opportunities and saying no to the wrong ones, because they just add work without compounding or without resonating with your central thesis? Is your work being discussed and forwarded beyond the people that you directly know? These shifts indicate that opportunities are starting to align with the direction that you desire to go, above and beyond pure attention that’s coming to you.

Ultimately, the difference between the default career path and the compounding career is that the default career relies on linear progress, where the inputs are more time, more effort, more volume, and more responsibility.

The Physician Leverage Flywheel, by contrast, relies on more trust, more signal, more opportunity, more optionality, and more leverage.

One more thing about time. The turns compound rather than simply add up, so a wheel with twenty years left to turn is not just accumulating more turns than one with five, each turn is increasing what the next one is worth. That means starting matters more than starting big, and it means the wheel doesn’t care how old you are when you give it its first push.

When you see an impressive, multifaceted career, remember:

What looks like luck from the outside is often a flywheel that has had years to work from the inside.

You are probably looking at the fifth turn of the wheel that someone has been quietly pushing since the first.

Physicians don’t need to do more things - they need to realize that they have more leverage than they’re aware of, but most of it is potential and latent leverage until it is connected.

The Physician Leverage Flywheel is that connection. It’s the engine that takes the holdings you already have access to and connects them to the network you already have.

If you are in the middle of a dry spell right now, tell me which turn you think you’re on: creation, attraction, compounding, or reinvesting. I’d be interested to know where the wheel feels stuck.

• Scott F. Cameron, MD is a practicing radiologist, AI implementation leader, angel investor, and MRS Past President. He writes about physician career architecture at Physician Vantage Studio.